HW 39 - Insights From Book - Part 2

Wagner , Marsden. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. University of California Press, 2006. Print.

A topic discussed in this book that "The Business of Being Born" did not touch upon is the interference of ACOG (The American College of Obstetricians and Gynecologists) in the world of obstetrics. ACOG tends to publish recommendations for how obstetricians should treat birth without providing any significant scientific data to back up these recommendations. This is one reason why so many obstetricians started using Cytotec in the 1990s - ACOG pretty much said it was okay to use it to induce labor (even though it sometimes caused uterine rupture). The book also has a whole chapter about how midwives are treated as inferior to doctors (even though becoming a midwife requires someone to attend many births before they are able to practice, unlike doctors, who might only see one or two births throughout their time in medical school) - this was something the movie mentioned, but did not go into detail about. 

The major insight the books seems to be communicating is on page 126: "Women in the United States have the right to choose who they want to attend the birth of their child, and they also have a choice regarding where the birth will take place - in a hospital, in an alternative birth center, or at home. These are two different choices; though if an American woman chooses a doctor as her birth attendant, she cannot choose a home birth, since doctors in the United States no longer attend home births. Home births are attended only by midwives, and since that represents a loss of business for doctors, doctors attack home births with zeal." My initial response to this was curiosity over whether women really do have these choices. He said that women have the right to choose who they want to attend their birth; however, the book also points out that there are times where a woman has a doula with her at the birth, but the doula gets kicked out by the doctors for "interfering". He also said women have the right to choose where they want the birth to take place. However, when there seems to be so much stigma associated with home birth, is choosing where to have a child really a choice? It can't be, if women aren't always given all the information they need to make the right decision for their own birth. 

Five interesting aspects of pregnancy and birth that deserve wider attention:

- "To give birth, a woman must open up her body, wide. This profound social and biological act requires everything a woman has and is. All maternity services should reflect this fundamental fact and should be designed to assist and support this woman. Most of the present care system for birthing women is designed not to assist the mother, but rather to control her." (190)

- Using an Electronic Fetal Monitor does not increase the chance of a healthy baby, and can increase the chance that invasive interventions (such as c-sections) will be done unnecessarily. (154)

- Every year, the National Center for Health Statistics reports an increase in home births attended by midwives. (151)

- "Fear of litigation has become an excuse that allows doctors to continue to use interventions such as induction of labor and C-section that they prefer to use for other reasons." (159)

- "Hospitals are highly symbolic of the medical model of birth - twenty-first century cathedrals with priests in white robes. A hospital is usually one of the biggest buildings in town, the halls are quiet, and outsiders are awed when they enter and feel reverence for those walking by dressed in white." (187)

A claim made in the second hundred pages of the book is: "Direct-entry midwives aren't even eligible to take the standardized national midwifery examination until they have attended at least fifty births, but there is no requirement for a labor and delivery nurse to have experience as a birth attendant before a hospital assigns her to monitor women in labor, and doctors who do not become obstetricians often finish medical school having attended, if they are lucky, maybe one or two births, but any M.D. is licensed to attend births" (117). I was surprised by the fact that there is a number of births that midwives have to be there for, so I researched whether that was true in all cases. I found a passage in the book Midwifery and Childbirth in America by Judith Rooks that states that midwives (as of 1981) must assist at fifty births and act as the primary attendant at another fifty throughout their three years of training. So the evidence the author gave was valid (although he actually understated it), and helped prove his point: that midwives go through a lot of training, and should not be considered inferior to doctors.